MHA Today | March 4, 2016

March 4, 2016

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Insights

On Wednesday, the most recent issue of Trajectories was released. This edition reviews the problem of opioid abuse through the lens of population health, and in the context of the 10 recommended strategies for use in emergency departments adopted by MHA and other leading provider organizations. The timing was perfect.

Yesterday, the Missouri House of Representatives adopted House Bill 1892, establishing a state prescription drug monitoring database. The House has adopted similar legislation in the past only to have the issue stall in the Missouri Senate — its next destination.

Thursday’s achievement in Jefferson City supplemented action by St. Louis County, which on Tuesday enacted a PDMD of its own. Not to be outdone, by Thursday, St. Louis City leaders were hinting at the idea of joining the county’s effort, and local government leaders in Kansas City were discussing local legislative options for their region.

St. Louis-headquartered pharmaceutical firm Mallinckrodt, maker of several scheduled drugs, underscored its support for a PDMD. It purchased full-page newspaper ads in several papers, including the Jefferson City News Tribune, saying it was “committed to working with patient groups, policymakers, law enforcement and other stakeholders to address the complex issues of opioid addiction and abuse.”

In Washington, D.C., Congress is debating a measure to authorize funding for programs to combat prescription drug and heroin abuse, in addition to increasing the availability of an emergency overdose drug. If the legislation is adopted, funding will be required.

Our recommendations in December were a first step in combating the problem in Missouri. These evidence-based guidelines for opioid prescriptions to manage noncancer-related chronic pain will help reduce the incidence of abuse and overdose as they are implemented. We’re making progress, but there’s much work to be done.

Missouri is the only state without a PDMD, and may remain so despite significant advocacy efforts from a broad coalition. The lack of a PDMD is troubling. However, as troubling is the potential for a patchwork of differing PDMDs in jurisdictions throughout the state. And, that’s where we get back to Trajectories and population health.

As much as St. Louis County’s action is positive, it evokes real questions about the delivery of care in a regional and statewide health care system. For example, will providers in St. Louis have different tools to track prescriptions than other parts of the state? Will reduced opioid-related utilization in St. Louis County cause migration to bordering counties? What will be the cost to hospitals there? What strategies will Jefferson, Lincoln, St. Charles or other Missouri counties in the region have to address these problems? Which counties or municipalities will act next, and will their program be the same? How will Medicaid’s CyberAccess database interact with these various initiatives?

Hospitals are working to improve the health of the communities they serve. As a hospital community, we’ve identified a problem, built a strong coalition of organizations supporting the effort and are implementing evidence-based solutions.

Sometimes unified action makes sense. After all, patients are unencumbered by city, county or state borders.

I can’t predict what will happen. I can say with confidence that we’re on the right side of history.

House Committee Endorses FRA Reauthorization

A state House committee has unanimously approved House Bill 1534, which would reauthorize the hospital Federal Reimbursement Allowance and several other provider taxes for an additional two years, through Sept. 30, 2018.

U.S. House Approves Medicaid Provider Bill

The U.S. House of Representatives has unanimously passed an amended version of H.R. 3716, dubbed the “Ensuring Access to Quality Medicaid Providers Act.” The legislation requires that providers blocked from participating in Medicare or one state’s Medicaid or CHIP program will be excluded from all state Medicaid and CHIP programs. Also, it requires states to publish a directory of physicians and, at a state’s option, other providers, who are available and were paid in the last year to treat fee-for-service enrollees.

Report Finds 20 Million People Are Insured Because Of The ACA

The U.S. Department of Health & Human Services released a new report that finds that provisions of the Affordable Care Act have resulted in an estimated 20 million people gaining health insurance coverage between 2010 and 2016. The total includes enrollment through the health insurance marketplace, Medicaid expansion and changes in private insurance that allow young adults to stay on their parent’s health insurance plans.

The U.S. Department of Health & Human Services announced that an estimated 30 percent of Medicare payments now are tied to alternative payment models. Last year, HHS announced the Better Care, Smarter Spending, Healthier People initiative, which set the goal to transition payments tied to the Medicare fee-for-service system to quality and alternative payment models. The recent announcement meets the 2016 goal for alternative payment models.

MHD Reminds Providers To Use 2016 CPT And HCPCS Codes

The MO HealthNet Division is reminding providers to use the 2016 Current Procedure Terminology and Healthcare Common Procedure Coding System for services provided on or after Jan. 1. For services provided prior to Jan. 1, claims must be filed using 2015 codes. A summary of the additions, deletions and revisions is found in the appendix of the CPT and HCPCS books.

CMS Issues Comprehensive Care For Joint Replacement Correction Notice

The Centers for Medicare & Medicaid Services released a correction notice related to the comprehensive care for joint replacement model. The CJR model affects hospitals in certain metropolitan statistical areas. In Missouri, hospitals located in the Cape Girardeau, Columbia, Kansas City and St. Louis MSA’s are required to participate in the model beginning Friday, April 1. The notice corrects several errors, including typographical errors, omission and addition of words, and clarifies the use of quality data and the effect on the target discount.

The Centers for Disease Control and Prevention released its annual Vital Signsreport, which focuses on the progress hospitals are making on health care-associated infections. The report notes that the health care field needs to be vigilant against antibiotic-resistant organisms (or “superbugs”), such as some strains of C. difficile and methicillin-resistant staphylococcus aureus. One approach is through the use of antibiotic stewardship programs.

The CDC also released an annual update to its National and State HAI Progress Report. Missouri’s acute care hospitals showed no significant change in HAI’s between 2013 and 2014; however, five of the six areas are performing better than the national average. However, Missouri catheter-associated urinary tract infection rates continue to underperform against the national average.

In addition, CDC launched its Antibiotic Resistance HAI Patient Safety Atlas, which provides interactive data about HAIs caused by antibiotic-resistant bacteria. The data is designed to be used by health departments and facilities to help prioritize infection control efforts, as well as for academic researchers, drug and device manufacturers and other interested parties.

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Consider This ...

Almost one million American physicians can write a prescription for an opioid painkiller, but regulatory hurdles and other factors only allow 32,000 to prescribe buprenorphine, a medication to treat opioid addiction.